Q: I did not have any symptoms at all, but my doctor tested me and told me I had hepatitis C. How can this be?

A: Hepatitis C (Hep C) is a blood-borne viral infection (there are several different subtypes) acquired by exposure to shared needles (for example in some IV drug abusers), contaminated medical equipment (rare in the U.S.), unscreened blood transfusions (the U.S. now screens blood products, but not all countries are able to), unprotected sex with an infected person or from an infected mom to her fetus (Hep C is NOT transmitted to baby from breast feeding). Globally, more than 150 million people have chronic Hep C infection; it kills half a million people every year.

Chronic Hep C affects more than 2.5 million Americans, and over 8,000 die from it every year. Even though the infection rate has dropped, about 30,000 new Hep C infections occur annually in the U.S.; about 60 percent are in IV drug abusers, 20 percent are acquired through sexual contact and the remainder through other exposures.

Three-quarters of people infected with Hep C do not have any acute symptoms; when someone does have symptoms, they are often non-specific, such as fatigue or myalgia. Acute infection with Hep C is only rarely associated with life-threatening liver failure, but some people do get symptoms of acute liver inflammation (which is what hepatitis means) a few weeks to months after infection, including jaundice (yellowing of the skin and the whites of the eyes), fever, nausea, vomiting, dark urine and/or pain in the right upper part of the abdomen (where the liver is).

Although 10 percent to 40 percent of people infected with Hep C spontaneously clear the virus without treatment, the majority (60 percent to 90 percent) develop chronic infection. As with acute infection, most patients with chronic Hep C initially have no symptoms. In fact, up to half of infected people do not know they are infected. When symptoms do occur, they are usually non-specific and/or involve other body organs such as joint aches, muscle aches, itchy skin/rashes or limitations of sensation/other nervous system involvement. Some people do develop signs of liver inflammation (as above).

Complications of chronic Hep C may include liver cirrhosis (over one-quarter of patients develop this within 20 years of infection) and (less commonly) liver cancer (hepatocellular carcinoma).

There is no vaccination to prevent Hep C (as there is for hepatitis A), although research is being done to develop one. Treatment for Hep C is able to eradicate the virus in 50 percent to 90 percent of patients (different subtypes have different response rates). However, treatment is quite expensive, and side effects are not uncommon. Once advanced cirrhosis has developed, liver transplant may be the only option.

Since Hep C is pretty common and has significant morbidity and mortality, often without any symptoms until the disease has progressed, and because effective treatment exists, screening should be considered in people with any of the risk factors noted above. In addition, some experts have recommended Hep C screening for anyone born between 1945 and 1965.

Page 2 of 2 - Screening is done with a blood test to look for antibodies to the Hep C virus. Although people with compromised immune systems (such as those with HIV) may have a false negative test (and hence require other screening), this test is sufficient screening for most people. Since some people who have been infected (and hence have a positive antibody test) spontaneously clear the virus, the next step is a specialized blood test to check for the presence of the virus itself. If no virus is found, chronic Hep C infection is essentially ruled out.

If virus is found, the amount of virus is then quantified and the subtype identified and the best treatment regimen can be determined. Tests to assess for liver damage, including other blood tests, and in some cases a liver biopsy to evaluate for fibrosis and cirrhosis (scarring of the liver which may compromise liver function), will then be done. New non-invasive tests for liver cirrhosis such as MR or ultrasound elastography have been developed.

Measures to avoid infection include using condoms, not sharing needles and minimizing other possible exposures (such as by ensuring tattoos and body piercings are done only at reputable places that use proper hygienic techniques and that do not reuse needles). Health-care facilities must ensure appropriate decontamination of medical equipment, appropriate hygiene of their staff and appropriate testing of blood and transplanted tissues. People with chronic Hep C should avoid alcohol (as this may hasten complications) and be sure to comply with their medication regimen and follow-up testing.